School entry health check

Overview

A school entry health check is a routine check-up for children around age 4 or 5, just before they start school. It helps make sure your child is healthy and ready to learn. The check looks at things like vision, hearing, growth, and development.

Yes, school entry health checks are a routine part of children's healthcare in many countries, including the UK.

Children around 4 to 5 years old who are about to start primary school or reception class.

Symptoms

Common symptoms

• The check itself does not cause symptoms. It looks for signs of possible issues such as vision or hearing problems, speech delays, or growth concerns.

Symptoms in children

• Not being able to see the board clearly or squinting
• Not hearing well or asking 'what?' often
• Trouble saying certain words or being hard to understand
• Being much shorter or taller than other children of the same age

Causes

Main causes

• The check is not caused by anything; it is a planned assessment to identify potential developmental or health issues.

Risk factors

• Premature birth or low birth weight
• Family history of vision or hearing problems
• Delays in early speech or motor skills
• Limited access to health care or early childhood services

When to see a doctor

See a doctor urgently if:

• If your child has sudden vision or hearing loss
• If your child has a seizure or loses consciousness
• If your child is in severe pain or has trouble breathing

Book a routine appointment if:

• At the scheduled school entry health check appointment
• If you are worried about your child's development before the check, talk to your health visitor or GP

Diagnosis

The school entry health check is a screening, not a diagnosis. If a problem is found, your child will be referred to a specialist (like an optician or audiologist) for a full assessment.

Tests that may be done

• Vision screening (reading letters or matching pictures)
• Hearing test (listening to quiet sounds through headphones)
• Growth measurement (height and weight plotted on a chart)
• Developmental review (questions about speech, movement, and behaviour)

What to expect at your appointment

The check usually takes about 20–30 minutes. Your child will be with a friendly nurse or health visitor who will make it feel like a game. You can stay with them the whole time.

Treatment

If the check finds a possible issue, treatment will depend on what it is. Early treatment often includes simple steps like glasses for vision, grommets for hearing, or speech therapy. Your healthcare team will guide you through the next steps.

Self-care at home

• Read to your child every day to boost language and listening skills
• Encourage outdoor play and physical activity for healthy growth
• Limit screen time and ensure your child gets enough sleep

Medical treatments

Treatments vary but may include prescription glasses, hearing aids, speech and language therapy, or referral to a paediatrician. No specific medication is given just for the check.

When is surgery considered?

Surgery is rarely needed after a school entry health check. If it is, it might be for something like persistent glue ear (grommets) or a squint that doesn't improve with glasses.

Living with this condition

If your child has a health or developmental need, work closely with their school and healthcare team. Small adjustments at home, like sitting near the front of the class or using hearing aids, can help them learn well.

Lifestyle tips

• Keep a regular bedtime and healthy routine
• Praise effort and celebrate small achievements
• Talk with your child about their day to encourage communication

Diet and exercise

A balanced diet with plenty of fruits, vegetables, and protein supports growth and brain development. Aim for at least 60 minutes of active play each day.

Mental health and emotional wellbeing

Starting school can be stressful for any child. If your child has additional needs, they may feel anxious or frustrated. Listen to them, validate their feelings, and keep the school informed so they can offer extra support.

Prevention

Most health issues found at the school entry check cannot be prevented, but early detection through regular checks helps prevent them from affecting a child's learning and development.

Vaccines

Vaccinations are usually up to date before school starts. Make sure your child has all their routine childhood vaccinations, which protect against serious illnesses.

Screening programmes

Vision and hearing screening at the school entry check are key examples of early detection. Regular developmental checks by your health visitor also help.

Complications

If left untreated

• Undetected vision problems can make it hard for a child to read or see the board, leading to poor school performance
• Untreated hearing loss can delay speech and language development
• Growth or developmental delays may worsen if not addressed early

Long-term outlook

Most issues found at the school entry check are mild and very treatable. With early support, children can catch up quickly and thrive at school. The outlook is very positive.

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